Outline

Between August 2008 and April 2009 an outbreak of pandrug-resistant Acinetobacter baumannii occurred in an intensive care unit (ICU) for burn patients. The outbreak strain was identified by pulsed-field gel electrophoresis (PFGE). 20 of 23 culture-positive cases were acquired nosocomially. Patients were 60 years on average, the majority were female (65%), and suffered second- and third-degree burns (61%). According to CDC-criteria, six patients had wound infections, and two patients had pneumonia. Of the 23 cases, 6 died during the hospital stay. Sampling of the environment showed a heavy contamination throughout the ICU. Yet were not able to identify a focal source for which the outbreak had originated. However, during the outbreak, a lack of proper hand hygiene, and an inadequate number of staff facilitated the transmission. In addition, structural problems such as a bath tub, which was difficult to clean properly, became evident. Despite the broad contamination of the ward with the pandrug-resistant Acinetobacter baumannii, we aimed at controlling the outbreak without closing down the unit. While the unit remained fully operational, we implemented multicomponent interventions including extensive environmental decontamination, educational programs for the staff, strict isolation, 1:1 patient care, additional hand desinfectant dispenser, improvement of the technique for surgical dressing, and usage of a suitable bath tub. Even so we failed to identify the origin for this outbreak, the implementation of a bundle of measures finally led to the termination of the outbreak.